Neurology Flashcards
1
Q
What are 4 things that could prompt an attack of trigeminal neuralgia?
A
- light touch
- cold / cold wind
- eating
- vibrations
2
Q
What is thought to be the cause of trigeminal neuralgia?
A
compression of trigeminal nerve by loop of artery or vein
3
Q
What is the medical treatment of trigeminal neuralgia?
A
carbamazepine first line (also oxcarbazepine; lamotrigine and baclofen also used in specialist setting)
4
Q
What is the surgical treatment option for trigeminal neuralgia?
A
decompression of trigeminal nerve or damaging it to avoid pain transmission
5
Q
How should medical treatment of trigeminal neuralgia be withdrawn?
A
once in remission for one month, should be slowly withdrawn
6
Q
What is the underlying pathophysiology of Lewy body dementia vs Parkinson’s disease dementia?
A
- Lewy body dementia - lewy bodies in cortical neurons
- PD dementia - lewy bodies in substantia nigra
7
Q
What is key clinical difference in Parkinson’s disease dementia vs. Lewy body dementia?
A
in PD, extrapyramidal symptoms precede cognitive symptoms by at least one year; in LBD these happen within 1 year of each other (tremor later in LBD, axial rigidity early, symptoms bilateral)
8
Q
What is the most common presentation of amyotrophic lateral sclerosis?
A
- asymmetrical limb weakness
- mixture UMN/LMN signs
- wasting of hands/anterior tibialis
- fasciculations
- absence of sensory signs
no cerebellar signs, doesn’t affect extraocular muscles
9
Q
What will NCS and EMG show in ALS?
A
NCS: normal motor conduction - helps exclude neuropathy
EMG: reduced number of action potentials with increased amplitude
10
Q
What is the general rule for the management of migraine (acute vs. prophylaxis)?
A
- 5HT agonists for acute episode
- 5HT antagonists for prophylaxis
11
Q
What is the treatment for acute migraine in adults vs. children?
A
adults: triptan + paracetamol/NSAID
children: 12-17y consider nasal triptan (rather than oral)
if ineffective - consider non-oral metoclopramide or prochlorperazine +- non-oral NSAID +- triptan
12
Q
When is migraine prophylaxis given?
A
if significant impact on QOL/ADLs e.g. >once a week or prolonged and severe
13
Q
What are the 3 options for migraine prophylaxis?
A
- amitriptyline
- propranolol
- topiramate
14
Q
What are 2 things NICE suggest if propranolol/ topiramate/ amitriptyline fail for migraine prophylaxis?
A
- acupuncture
- riboflavin 400mg / day
15
Q
What are 2 treatment options outside of NICE guidelines for migraine that specialists may consider?
A
- candesartan
- monoclonal antibodies that target calcitonin gene related peptide (CGRP) receptor e.g. erenumab
16
Q
What is the NICE guidance regarding IV dexamethasone in meningitis in adults?
A
consider it as adjunctive treatment particularly if pneumococcal meningitis suspected, preferably starting before or with first dose of antibiotic (no later than 12 hours after starting)
17
Q
What are 4 contraindications to IV dexamethasone in the treatment of meningitis?
A
- septic shock
- meningococcal sepsis
- immunocompromised
- meningitis following surgery
18
Q
What are 4 situations when lumbar puncture should be delayed in meningitis?
A
- severe sepsis / rapidly evolving rash
- severe resp / cardiac compromise
- significant bleeding risk
- signs of raised ICP: focal neurology, papilloedema, continuous / uncontrolled seizures, GCS 12 or less
19
Q
What are 7 things to send CSF for after LP in meningitis?
A
- glucose
- protein
- MCS
- lactate
- meningococcal + pneumococcal PCR
- enteroviral, herpes simplex and VZV PCR
- consider TB meningitis investigations
20
Q
Which groups should have amoxicillin as well as IV cefotaxime for meningitis?
A
< 3 months old OR >65 years old, confirmed caused by Listeria
21
Q
What antibiotic should be used if a patient has an allergy to penicillin / cephalosporins + needs treatment for meningitis?
A
chloramphenicol
22
Q
What prophylaxis is given to close contacts of bacterial meningitis?
A
ciprofloxacin first line (also rifampicin)
23
Q
If meningitis is confirmed as meningococcal, what extra measure should be taken for prophylaxis for contacts?
A
meningococcal vaccination (booster doses if had it in infancy)
24
Q
What are 3 steps for managing acute migraine?
A
- simple analgesia +- antiemetic (aspirin/ibuprofen)
- rectal analgesia + antiemetic
- triptan
25
What are 2 first-line prophylactics for migraine?
1. betablockers
2. amitriptyline
(valproate and topiramate used by specialists in secondary care)
26
What criterion must cluster headaches meet to be diagnosed as a cluster headache?
>5 attacks occuring, from 1 every other day to 8 per day with no other cause for the headache
27
What are 3 aspects of the acute maangement of cluster headache?
1. expert advice
2. SC sumatriptan
3. hyperbaric oxygen
28
What are 2 aspects of cluster headache prophylaxis?
1. prednisolone - high dose in short course
2. verapamil
29
What are the nerve roots responsible for the knee jerk reflex?
L3/4
30
What are the nerve roots responsible for the ankle jerk reflex?
S1/2
31
What are the the nerve roots responsible for the biceps reflex?
C5/6
32
How is a decision on first line treatment in Parkinson’s disease made?
* motor symptoms affecting QOL: levodopa
* motor sx not affecting QOL: non-ergot derived levodopa, dopamine agonist (E.g. cabergoline), MAO-Bi
33
What is second line treatment for Parkinson’s disease if a patient does not respond to optimal levodopa treatment / develops dyskinesias?
Addition of:
* dopamine agonist
* MAO-Bi
* COMT inhibitor
34
What are 3 key side effects of anti-Parkinsons’s medication?
* sedation
* hallucinations
* impulse control disorders
35
What are 2 effects of not taking / absorbing anti Parkinson’s medication?
* acute akinesias
* neuroleptic malignant syndrome
36
What medication can be used for excessive daytime sleepiness in PD?
Modafinil
37
What can be used for ortho static hypotension in PD?
Stop offending meds, midodrine
38
What can be used to treat drooling in PD?
Glycopyrronium bromide
39
What drug can be used for excessive drooling in PD?
Glycopyrronium bromide
40
What drug is nearly always combined with levodopa and why?
Decarboxylase inhibitor - reduces peripheral metabolism of levodopa to limit side effects
41
What are 5 common adverse effects of levodopa?
1. Dry mouth
2. Anorexia
3. Palpitations
4. Postural hypotension
5. Psychosis
42
What are 3 types of dyskinesias seen at peak dopamine dose?
1. Dystonia
2. Chorea
3. Athetosis
43
What are 4 examples of dopamine receptor agonists?
1. Bromocriptine (ergot)
2. Cabergoline (ergot)
3. Ropinirole
4. Apomorphine
44
What are 4 key side effects of dopamine agonists?
1. Pulmonary / cardiac / retroperitoneal fibrosis
2. Sedation
3. Impulse control disorders
4. Hallucinations
45
What is an example of a MAO-B inhibitor?
Selegiline
46
What is the mechanism of MAO-Bi for PD?
Inhibit breakdown of dopamine released by dopaminergic neurons
47
What are 5 side effects of amantadine?
1. Dizziness
2. Confusion
3. Ataxia
4. Slurred speech
5. Livedo reticularis
48
What are 2 examples of COMT-inhibitors?
1. Entacapone
2. Tolcapone
49
What is the mechanism of COMT inhibitors?
COMT is an enzyme involved in the breakdown of dopamine, and hence inhibitors may be used as an adjunct to levodopa therapy
50
When are antimuscarinics used in Parkinson’s?
Drug induced Parkinsonism
51
What are 3 antimuscarinic drugs that can be used for drug-induced Parkinsonism?
1. Procyclidine
2. Benzotropine
3. Trihexyphenidyl (benzhexol
52
How are seizures classified?
* focal onset - retained awareness or impaired awareness
* generalised onset - motor and non motor (absence)
| in generalised - awareness always impaired
53
What is the definition of epilepsy?
* 2 or more unprovoked seizures occuring >24 hours apart OR
* 1 unprovoked seizure AND the probability of further seizures similar to general recurrence risk after 2 unproboked seizures (>60% over next 10y)
54
Is dementia a risk factor for seizures?
Yes - people with Alzheimer's disease are up to 10x more likely to develop epilepsy
55
Where in the brain do focal impaired awareness seizures most commonly arise from?
temporal lobe
56
When is treatment with benzodiazepine indicated in a seizure?
* tonic-clonc seizure lasting >5 minutes
* >3 seizures in an hour
57
What is first line benzo treatment for seizures in the community?
buccal midazolam
| rectal diazepam if preferred, IV lorazepam if IV access established
58
What are 3 methods of contraception that don't interact with enzyme-inducing anti-epileptic drugs?
1. medroxyprogesterone acetate injections
2. IUS
3. IUD
59
What is the first line treatment for generalised tonic-clonic seizures in a) males b) females?
* a) sodium valproate
* b) lamotrigine or levetiracetam
| lamotrigine second line for males
60
What are the first and second line AED for focal seizures?
* **first line:** lamotrigine or levetiracetam
* **second line:** carbamazepine, oxcarbazepine or zonisamide
61
What are first and second line AEDs for absence seizures (petit mal)?
* **First line:** ethosuximide
* **Second line:** sodium valproate (M), lamotrigine or levetiracetam (F)
62
Which AED may exacerbate absence seizures?
carbamazepine
63
What is first line in a) males and b) females for myoclonic seizures?
* a) sodium valproate
* b) levetiracetam
64
What is first line in a) males and b) females for myoclonic seizures
* a) sodium valproate
* b) lamotrigine
65
When can AED medication be withdrawn in someone with epilepsy?
if seizure-free for >2 years
66
What does ILAE consider as epilepsy having resolved?
* if seizure-free for past 10 years
* no AED treatment for at least past 5y
67
What 6 things that cause a predominantly motor loss-type peripheral neuropathy?
1. Guillain-Barre syndrome
2. porphyria
3. lead poisoning
4. hereditary sensorimotor neuropathies - e.g. Charcot-Marie Tooth
5. Chronic inflammatory demyelinating polyneuropathy (CIDP)
6. diphtheria
68
What are 6 things which cause a predominantly sensory loss-type periphera; neuropathy?
1. diabetes
2. uraemia
3. leprosy
4. alcoholism
5. vitamin B12 deficiency
6. amyloidosis
69
What can occur secondary to B6 (pyridoxine) overdose?
peripheral neuropathy (also used as treatment in isoniazid-induced neuropathy)
70
What are 5 drugs which are risk factors for IIH?
1. COCP
2. steroids
3. tetracyclines
4. retinoids (isotretinoin) / vit A
5. lithium
71
What are 6 aspects of treatment in IIH?
1. weight loss
2. specialists may initiate meds like semaglitide and topiramate
3. acetazolamide
4. repeated LP
5. optic nerve sheath decompression and fenestration
6. LP or VP shunt
72
What is Lhermitte sign?
In MS flexion of the neck causes paraesthesia of limbs (due to disease near dorsal column nuclei of cervical cord)
73
What are 2 possible triggers for cluster headaches?
1. alcohol
2. nocturnal sleep pattern
74
Which antiplatelet therapy is used lifelong in stroke/TIA?
Clopidogrel
75
When should anticoagulation be started in AF leading to stroke vs TIA?
* **stroke**: commence after 2 weeks (delay if very large infarction)
* **TIA**: immediately once imaging has excluded haemorrhage
76
What is a lacunar infarct?
involve occlusion of single penetrating branch of a large cerebral artery and affect internal capsule, thalamus and basal ganglia
77
What are 5 types of presentation of a lacunar infarct?
1. purely motor (commonest)
2. purely sensory
3. sensorimotor
4. ataxic hemiparesis (ipsilateral weakness + limb ataxia out of proportion to motor deficit)
5. dysarthria - clumsy hand syndrome
| lack cortical findings - aphasia, agnosia, neglect, apraxia, hemianopia
78
How should decisions about thrombectomy take into account a patient’s clinical status?
Pre-stroke functional status should be <3 on modified Rankin scale and NIHSS score >5
79
How should decisions about thrombectomy take into account a patient’s clinical status?
Pre-stroke functional status on Modified Rankin score of <3 and NIHSS score >5
80
Within what time frame should thrombectomy be offered for anterior circulation stroke?
- as soon as possible and within 6 hours of onset (with IV thrombolysis if within 4.5h)
- as soon as possible if last well between 6-24h ago (including wake up strokes AND demonstrated salvageable brain tissue on CT perfusion scan or MRI with diffusion weighting showing limited infarct core volume
81
Within what time frame should thrombectomy be offered for PROXIMAL posterior circulation stroke?
Consider thrombectomy (+ thrombolysis if within 4.5h) ASAP if last well up to 24h previously and salvageable tissue on perfusion CT or diffusion-weighted MRI
MUST BE PROXIMAL (basilar or posterior cerebral artery)
82
What are 3 key ways that Listeria infection may present?
1. Gastroenteritis
2. Bacteraemia - flu-like illness
3. CNS infection - meningoencephalitis, ataxia, seizures
83
What are 3 types of presentation of Listeria?
1. Gastroenteritis
2. Bacteraemia - flu like illness
3. CNS infection - meningoencephalitis, ataxia, seizures
84
How is Listeria spread?
Contaminated food - usually unpasteurised dairy products
85
What are 4 risk factors for Listeria infection?
1. Elderly
2. Neonates
3. Immunosuppression - especially steroids
4. Pregnancy
86
What are 2 key ivv bc estimations to diagnosis listeriosis?
- blood cultures - tumbling motility on wet mount
- LP for CSF sampling - pleocytosis, often lymphocytes, raised protein, reduced glucose
87
What is the management of Listeria / listeria meningitis?
- amoxicillin / ampicillin
- IV amoxicillin / ampicillin + gentamicin
88
What nerve roots supply the sciatic nerve?
L4-5, S1-3
89
Which 2 nerves does the sciatic nerve divide into?
1. tibial nerve
2. common peroneal nerves
90
Which muscles are supplied by the sciatic nerve? Give 2
1. hamstring muscles
2. adductor muscles
91
What are 4 features of sciatic nerve lesions?
1. paralysis of knee flexion
2. paralysis of all movements below knee
3. sensory loss belowknee
4. ankle and plantar reflexes lost, knee jerk intact
92
What are 3 causes of sciatic nerve lesions?
1. fractured neck of femur
2. posterior hip dislocation
3. trauma
93
How does CNS tuberculous disease develop?
haematogenous spread, 2 stages (Rich + McCordock):
* small tuberculous lesions (Rich's foci) develop in CNS, during bacteraemia of primary infection or shortly afterwards; can be dormant for year
* later, rupture/growth produces development of CNS tuberculosis
94
How can CNS TB present?
meningitis or intracranial tuberculomas
95
# ```
```
What do investigations show in meningeal TB?
* CSF examination
* head CT or MRI can show oedema, hydrocephalus, basilar meningeal thickening, or tuberculomas
96
What do investigations show in tuberculomas?
* diagnosis based on CT/MRI
* CSF usually normal
97
What is the management of CNS TB?
RIPE for 2 months
RI for 10 months
| rifampicin, isoniazid, pyrazinamide, ethambutol
98
What is the mechanism of action of triptans?
specific 5-HT1B and 5-HT1D agonists
99
At what point during a migraine should triptans be taken?
as soon as possible after the onset of headache, rather than at onset of aura
100
What are 5 adverse effects of triptans?
1. tingling
2. heat
3. tightness (e.g. throat and chest)
4. heaviness
5. pressure
101
What is a key contraindication to triptans?
patients with a h/o or significant risk factors for, **ischaemic heart disease** or **cerebrovascular disease**
102
What dermatome is supplied by C2 nerve root?
posterior half of the skull (cap)
103
What is the distribution of dermatome C3?
high turtleneck shirt
104
What is the dermatome distribution of C4?
low collar shirt
105
What is the dermatome distribution of C5?
ventral axial line of upper limb
106
What is the dermatome that supplies the thumb and first finger?
C6 (make 6 with L hand by touching the tip of thumb + index finger together)
107
What dermatome supplies the middle finger and palm?
C7
108
What dermatome supplies the ring and little finger?
C8
109
Which dermatome supplies the inframammary fold?
T5 (T4 = nipples)
110
What dermatome supplies the xiphoid process?
T6
111
Which dermatome supplies the belly button?
T10
112
Which dermatome supplies the inguinal ligament?
L1
113
Which dermatome supplies the knee caps?
L4
114
Which dermatome supplies the big toe and dorsum of the foot?
L5 (L5 = largest of the 5 toes)
115
Where does S1 dermatome supply?
S1 = the smallest one = lateral foot and small toe
116
Which dermatomes supply the genitalia?
S2 + S3
117
How long do menopausal symptoms typically last for?
7 years
118
What are the lifestyle modifications to help manage different symptoms of the menopause?
* hot flushes: regular exercise, weight loss and reduce stress
* sleep disturbance: avoid late evening exercise, good sleep hygiene
* mood: sleep, regular exercise + relaxation
* cognitive sx: regular exercise and good sleep hygiene
119
What are 4 contraindications to HRT?
1. current or past breast cancer
2. oestrogen-sensitive cancer
3. undiagnosed vaginal bleeding
4. untreated endometrial hyperplasia
120
What are 5 key risks of HRT?
1. VTE (if oral; no increased risk if transdermal)
2. stroke
3. coronary heart disease
4. breast cancer
5. ovarian cancer
121
What is the preferred antibiotic prophylaxis of contacts with meningitis?
ciprofloxacin (now preferred over rifampicin)
122
When do NICE advice against giving corticosteroids in children?
children <3 months
123
What are 3 situations when NICE advise consider dexamethsone in meningitis?
1. frankly purulent CSF
2. CSF WCC>1000
3. raised CSF WCC with protein concentration >1g/L
4. bacteria on gram stain
124
What is the guidance for driving following first unprovoked/isolated seizure?
6 months off
125
What is the guidance for driving for patients with established epilepsy/multiple unprovoked seizures?
may qualify to drive if seizure free for 12 months
126
What is the guidance for driving after withdrawal of epilepsy medication?
should not drive whilst being withdawn and for 6 months afterwards
127
What is the guidance for driving after syncope?
* simple faint - no restriction
* single episode, explained and treated: 4 weeks off
* single episode, unexplained: 6 months off
* 2 or more episodes: 12 months off
128
What is the guidance for driving after stroke or TIA?
1 month off driving, may not need to inform DVLA if no residual neurological deficit
129
What i the guidance for driving after multiple TIAs over short period of time?
3 months off and inform DVLA
130
What is the guidance for driving with chronic neurological disorders e.g. multiple sclerosis, motor neuron disease?
inform DVLA, complete PK1 form
131
What are 3 things that are different about paediatric migraine from adults?
1. attacks may be shorter-lasting
2. headache more commonly bialteral
3. GI disturbance more prominent
132
What are the patterns of radial nerve damage?
* wrist drop
* sensory loss to small area between the dorsal aspect of the 1st and 2nd metacarpals
* if axillary damage - paralysis of triceps as well
133
What are 4 features associated with an essential tremor?
1. postural tremor - worse when arms outstretched
2. improved by alcohol and rest
3. titubation
4. strong family history (often)
134
What is meant by the ulnar paradox in ulnar nerve lesions?
clawing more severe in distal ulnar nerve lesions
135
What features will be seen in ulnar nerve damage at the elbow?
* claw hand (less severe than more distal lesion - ulnar paradox)
* wasting + paralysis of intrinsic hand muscles + hypothenar muscles
* sensory loss medial 1.5 fingers (palmar and dorsal aspects)
* radial deviation of wrist
136
What features will be seen in ulnar nerve damage at the wrist?
* claw hand (less severe than more distal lesion - ulnar paradox)
* wasting + paralysis of intrinsic hand muscles + hypothenar muscles
* sensory loss medial 1.5 fingers (palmar and dorsal aspects)
137
What is first-line management of migraine in children < 12 / 12-17 / > 18?
* < 12: oral ibuprofen
* 12 - 17: sumatriptan nasal spray
* >18 - oral sumatriptan
138
What is the most common cause of primary headache in children?
migraine without aura
139
What are 7 red flag symptoms and signs suggesting a serious underlying cause of trigeminal neuralgia?
1. **sensory** changes
2. **deafness** or other ear problems
3. history of skin or oral **lesions** that could spread perineurally
4. pain **only** in **ophthalmic** division
5. **optic neuritis**
6. **FH** of MS
7. age **< 40 years**
140
Which muscle is weak in carpal tunnel syndrome and how does this present on exam?
abductor pollicis brevis - weakness of thumb abduction
141
What are 5 causes of carpal tunnel syndrome?
1. idiopathic
2. pregnancy
3. oedema e.g. heart failure
4. lunate fracture
5. RA
142
What will electrophysiology show in carpal tunnel syndrome?
prolongation of action potential (motor and sensory)
143
What are the treatment options for carpal tunnel syndrome?
* mild-moderate: 6 week trial of conservative management - steroid inj, wrist splints at night
* severe / persistent: surgical decompression (flexor retinaculum division)
144
What is the underlying pathology in Guillain-Barre syndrome?
* immune-mediated demyelination fo peripheral nervous system - progressive, symmetrical weakness of limbs
* often ascending pattern
* diminished reflexes
* normal sensation
145
What is the pathophysiology of GBS?
* cross-reaction of antibodies with gangliosides in the PNS
* correlation between anti-ganglioside antibody (e.g. anti-GM1) + clinical features
146
How many patients with GBS have anti-GM1 antibodies?
25%
147
What is Miller Fisher syndrome?
variant of GBS with ophthalmoplegia, areflexia and ataxia
148
Which muscles are typically affected first in Miller Fisher syndrome?
eye muscles
149
How does the presentation of Miller Fisher syndrome differ from GBS?
descending paralysis rather than ascending
150
Which antibodies can be seen in Miller Fisher syndrome and what proportion are they seen in?
* anti-GQ1b antibodies
* 90% of cases
151
What may precede neurological findings in GBS?
65% of patients experience back/leg pain in initial stages
152
Why is papilloedema sometimes seen in GBS?
reduced CSF resorption
153
What are 2 key investigations in GBS and what will they show?
1. LP - high protein, normal WCC (aluminocytologic dissociatin)
2. NCS - decreased nerve conduction velocity, prolonged distal motor latency, increased F wave latency
154
What is the dose of IM benzylpenicilline for meningococcal sepsis in children < 1 year?
300 mg
155
What is the dose of IM benzylpenicilline for meningococcal sepsis in children 1 - 10 years?
600 mg
156
What is the dose of IM benzylpenicilline for meningococcal sepsis in children < 10 years?
1200mg
157
What medication + for what duration is given in stroke in someone intolerant to clopidogrel?
aspirin + dipyridamole lifelong
158
What 4 things are spared in motor neuron disease?
1. sensory signs
2. extraocular muscles spared
3. no cerebellar signs
4. abdominal reflexes usually preserved
159
Which extremity is affected more in anterior cerebral artery stroke?
lower
160
What is affected more in middle cerebral artery stroke, upper or lower extremity?
upper
161
What are 3 classical features of middle cerebral artery stroke?
1. contralateral hemiparesis and sensory loss
2. contralateral homonymous hemianopia
3. aphasia
162
What are 2 classical features of a posterior cerebral artery stroke?
1. contralateral homonymous hemianopia with macular sparing
2. visual agnosia
163
What vessel is affected in Wallenberg syndrome?
posterior inferior cerebellar artery (aka lateral medullary syndrome)
| **PICA**
164
Which blood vessel is affected in Weber's syndrome?
branches of the posterior cerebral artery that supply the midbrain
165
What blood vessel is affected in lateral pontine syndrome?
anterior inferior cerebellar artery
| **AICA**
166
What are 4 classic features of Wallenberg syndrome?
1. ipsilateral facial pain and temperature loss
2. contralateral limb/torso pain and temperature loss
3. ataxia
4. nystagmus
167
What are the classic features of lateral pontine syndrome?
similar to Wallenberg syndrome
ipsilateral facial paralysis and deafness
168
Which artery is affected by stroke in locked in syndrome?
basilar artery
169
What electrolyte abnormality can be caused by phenytoin?
hypocalcaemia
170
What is the antiplatelet therapy (+ dose) after a stroke?
* aspirin 300mg OD for 2 weeks
* then clopidogrel 75mg lifelong
171
What are the indications for disease modifying drugs in multiple sclerosis?
* relapsing-remitting: 2 or more relapses in last 1 year and able to walk >100m unaided
* secondary progressive: 2 or more relapses in last 2 years and able to walk >10m unaided
172
What are 5 examples of disease modifying drugs used for MS?
1. natalizumab
2. ocrelizumab
3. fingolimod
4. beta-interferon
5. glatiramer acetate
173
What are 3 options for the treatment of fatigue in MS?
* amantadine
* CBT
* mindfulness
174
What are the 2 first line options for spasticity in MS?
1. baclofen
2. gabapentin
175
In addition to the 2 first-line drugs to treat MS spasticity, what are 3 other options?
1. diazepam
2. dantrolene
3. tizanidine
| cannabis + botox under investigation
176
What must be done before the treatment of bladder dysfunction in MS?
US to assess bladder emptying - whether significant residual volume or not
177
What are the options to treat baldder dysfunction in MS?
* significant residual volume on US: intermittent self-catheterisation
* no significant residual volume: anticholinergics
178
What is first-line to treat oscillopsia in MS?
gabapentin
179
What is the inheritance pattern of tuberous sclerosis?
autosomal dominant
180
What are 5 cutaneous features of tuberous sclerosis?
* ash leaf spots over skin - fluorescence under UV light
* Shagreen patches - thickened skin near spine
* adenoma sebaceum (angiofibromas) - butterfly distribution over nose/cheeks
* subungual fibromata
* cafe-au-lait spots
181
What are 3 neurological features of tuberous sclerosis?
1. developmental delay
2. epilepsy - infantile spasms or partial
3. intellectual impairment
182
What are 5 types of cyst / tumours that can occur in tuberous sclerosis?
1. retinal hamartomas - dense white areas on retina (phakomata)
2. rhabdomyomas of heart
3. gliomatous changes in brain lesions
4. polycystic kidneys, renal aniomyolipomata
5. lymphangioleiomyomatosis - multiple lung cysts
183
What is the management of acute confusion when antipsychotics are needed in patient with Parkinson's?
quetiapine and clozapine (atypical antipsychotics)
184
Which type of virus causes temporal lobe encephalitis?
herpes simplex 1
185
What is the EEG pattern seen in HSV encephalitis?
lateralised periodic discharges at 2 Hz
186
What is the classic EEG finding in absence seizures?
3 Hz spike and wave
187
Which nerve is affected in meralgia paraesthetica?
lateral femoral cutaneous nerve (LFCN)
188
Which spinal roots does the lateral femoral cutaneous nerve originate from?
L2-3
189
What are 7 risk factors for meralgia paraesthetica?
1. obesity
2. pregnancy
3. tense ascites
4. trauma
5. iatrogenic - pelvic osteotomy, spinal surgeries, laparoscopic hernia repair, bariatric surgery
6. gymanastics, football, bodybuilding, strenuous exercise
7. male > female
190
What signs may be seen on examination in meralgia paraesthetica?
symptoms reproduced by deep palpation just below ASIS (pelvic compression) + hip extension
altered sensation over upper lateral aspect of thigh
no motor weakness
191
What investigations are done for meralgia?
* pelvic compressino test - highly sensitive
* injectin of nerve with LA - abolishes pain
* NCS
192
What is the management of myasthenia gravis?
* temporary treatment of muscle weakness: pyridostigmine (Ach esterase inhibitor)
* generalised disease: immunomodulatory - steroids, azathioprine, ciclosporin, myocphenolate mofetil
* monoclonal antibodies e.g. rituximab
* PLEX / IVIG in exacerbations
193
What GCS corresponds to different AVPU scores?
* A = 15
* V = 12
* P = 8
* U = 3
194
What are 2 classic features of Weber's syndrome?
1. Ipsilateral CN III palsy
2. Contralateral weakness of upper and lower extremity
195
What is Saturday night palsy?
compression of the radial nerve against the humeral shaft (often due to sleeping on hard chair with hand draped over the back)
196
What are 5 atypical aura symptoms for migraine, that may prompt further investigation / referral?
1. motor weakness
2. double vision
3. visual symptoms affecting only 1 eye
4. poor balance
5. decreased level of consciousness
197
What is the first line antibiotic recommended by the BNF for all cases of meningitis (apart from Listeria)?
IV cefotaxime (or ceftriaxone)
